Efficacy of a Surgical Site Infection Scorecard for Quality Improvement in Haiti

Author(s):
Jessie Codner; Jahanvi Srinivasan; Carla Haack; Jyotirmay Sharma

Background:

Surgical site infections (SSI) are one of the main complications to arise after any type of surgery. These complications are compounded in low resource settings, where patients have less follow up care, and hospitals have less means to deal with the sequelae of surgical wound infections. SSI can contribute to more severe complications including sepsis and mortality. For these reasons, it becomes even more important to prevent the development of an SSI in low and middle income countries (LMIC). The WHO produced a “Safe Surgery Checklist” for the prevention of SSI for global surgery. Our goal with this project was to track the risk factors specified by the WHO in our patients over a 4-week surgical mission trip to Pignon, Haiti by using an SSI scorecard system. The scorecard was used to stratify each patient’s risk of SSI, and overall variable incidence data was then used to evaluate quality improvement steps for the prevention of SSI on subsequent trips to Haiti.

Hypothesis:

A SSI scorecard can accurately stratify risk of SSI and improve postoperative antimicrobial stewardship.

Methods:

An eleven-element SSI scorecard was completed for each operative patient (n= 54), General Surgery (n=32), Urology (n=10), and Head & Neck (n=12). The cumulative value of the scorecard was used to risk stratify each patient for development of SSI. (0-2)-Low Risk (n=18), (3-4)- Intermediate Risk (n=30), (>4)- High Risk (n=6). We then calculated the incidence of each variable for the entire study population.

Results:

Follow-up was performed in 41 patients with a mean follow up of 8.6 ± 4.9 days. We had 2 patients with a SSI in our cohort (4.8% n=41). These patients with SSIs had scores of 3 and 5, a perineal incision and a prostatectomy, respectively. Mean score of the scorecard was 2.9 ± 1.2 (n=54).  Variable Incidence (n=54): Age >50 (30%), Malnutrition (BMI <18.5) (17%), Pre-op Antibiotics (Abx) not indicated (22%), Surgery time > 1 hr (54%), Clean Contaminated (39%), Contaminated (4%), Drain Indicated and not placed (9%) (n=11), No Post-op Abx (54%).

Conclusions:

Implementation of scorecards can help stratify SSI risk and guide antibiotic stewardship preoperatively and postoperatively in LMIC. SSI risk is highly variable and should be assessed for individual patients undergoing surgery.